Human Papilloma viruses (HPVs) is a class of virus which causes an infection that is easily spread through direct sexual contact, from the skin and mucous membranes of infected people to the skin and mucous membranes of their partners. It causes penile cancer in men and cervical, vaginal, anal & vulvar cancer in women. It can also cause throat or rectum cancer in both men and women. The virus is transmitted through intimate contact like – sexual intercourse, oral or anal sex. It poses a higher risk for HIV-infected persons, smokers, and people dependent on hormonal contraceptives.

Body:

Challenges around the vaccination for HPV:

• India has the largest burden of cervical cancer in the world and about 70,000 women die because of it each year.
• Around 70% of these cases are caused by infections from HPV strains, which the vaccines prevent.
• In India, two vaccines namely “Gardasil” & “Cervarix” are available.
• These vaccines protects against almost 90% of genital warts in men and women.
• The HPV vaccine is given thrice within six months to girls aged 9-13 years, before they become sexually active.
• Post-vaccination, a girl should ideally undergo pap smear tests every three years to check for pre-cancerous or cancerous cells.
• Punjab and Delhi have already begun vaccination for girls.
• National Technical Advisory Group on Immunisation (NTAGI) has proposed the inclusion of these vaccines in UIP for nationwide implementation.
• However, the medical community in India is divided over the vaccine’s utility.

Views opposing HPV vaccination:

• The cost of the vaccine is around INR 12,000 per person and the budget to cover a huge population are the major challenge in India.
• With 6.2 crores Indian girls aged 9-13 years, the cost to the government will be over Rs 56,000 crores.
• Also there is no data to suggest that they comprehensively prevent invasive cervical cancer as evaluation requires long testing periods.
• HPV vaccine has also been found to have side-effects such as regional pain syndrome and neurological problems in some cases.
• Contrarily, India is already witnessing a declining trend in cervical cancer due to better nutrition, hygiene & reproductive patterns.
• Hence, a case for improving these aspects further, rather than expose the entire population to the vaccination holds ground.

Views supporting HPV vaccination:

• ‘WHO Global Advisory Committee for Vaccine Safety (GACVS)’ had concluded that there the HPV vaccines are safe.
• 71 countries had introduced HPV vaccine in their immunisation programme for girls and 11 countries included boys too.
• Australia was the first country to introduce HPV vaccination in its school program and now has the lowest level of cervical cancer.
• In India there is already enough manpower and cold storage for vaccines.
• Hence, some argue that the prevention cost will be lower than treatment cost.
• As, awareness on prevention of HPV infections and safe sex is low in India, there is a view that it can’t be solely relied to fight HPV.

Conclusion:

The efforts needs to be scaled-up in low and middle-income countries (LMICs), where the burden of disease is far greater than in high-income countries. Redoubling our efforts to tackle the fiscal, supply, and programmatic barriers that currently limit HPV vaccine programmes; with these efforts, HPV vaccination could become a hallmark investment of cancer prevention in the 21st century